Provider Demographics
NPI:1104940659
Name:TEDESCO, VINCENT (RPH)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:TEDESCO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 TARRYTOWN RD.
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607
Mailing Address - Country:US
Mailing Address - Phone:914-683-0360
Mailing Address - Fax:914-683-1397
Practice Address - Street 1:399 TARRYTOWN ROAD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607
Practice Address - Country:US
Practice Address - Phone:914-683-0360
Practice Address - Fax:914-683-1397
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist